title: Effect of a nurse-coordinated prevention programme on cardiovascular risk after an acute coronary syndrome: main results of the RESPONSE randomised trial.
abstract: OBJECTIVE
  To quantify the impact of a practical, hospital-based nurse-coordinated prevention programme on cardiovascular risk, integrated into the routine clinical care of patients discharged after an acute coronary syndrome, as compared with usual care only.
  
  
  METHODS
  RESPONSE (Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists) was a randomised clinical trial.
  
  
  METHODS
  Multicentre trial in secondary and tertiary healthcare settings.
  
  
  METHODS
  754 patients admitted for acute coronary syndrome.
  
  
  METHODS
  A nurse-coordinated prevention programme, consisting of four outpatient nurse clinic visits, focusing on healthy lifestyles, biometric risk factors and medication adherence, in addition to usual care.
  
  
  METHODS
  The main outcome was 10-year cardiovascular mortality risk as estimated by Systematic Coronary Risk Evaluation at 12 months follow-up. Secondary outcomes included Framingham Coronary Risk Score at 12 months, in addition to changes in individual risk factors. Risk factor control was classified as 'poor' if 0 to 3 factors were on target, 'fair' if 4 to 6 factors were on target, and 'good' if 7 to 9 were on target.
  
  
  RESULTS
  The mean Systematic Coronary Risk Evaluation at 12 months was 4.4 per cent (SD 4.5) in the intervention group and 5.4 per cent (SD 6.2) in the control group (p=0.021), representing a 17.4% relative risk reduction. At 12 months, risk factor control classified as 'good' was achieved in 35% of patients in the intervention group compared with 25% in the control group (p=0.003). Attendance to the nurse-coordinated prevention programme was 92%. In the intervention group, 86 rehospitalisations were observed against 132 in the control group (relative risk reduction 34.8%, p=0.023).
  
  
  CONCLUSIONS
  The nurse-coordinated hospital-based prevention programme in addition to usual care is a practical, yet effective method for reduction of cardiovascular risk in patients with coronary disease. Our data suggest that the counselling component of the programme may lead to a reduction in hospital readmissions.
  TC1290.
authors.affiliation: Department of Cardiology, Academic Medical Center-University of Amsterdam, Amsterdam, Noord Holland, The Netherlands. h.t.jorstad@amc.uva.nl
authors.forename: Harald T
authors.initials: HT
authors.lastname: Jorstad
authors.forename: Clemens
authors.initials: C
authors.lastname: von Birgelen
authors.forename: A Marco W
authors.initials: AM
authors.lastname: Alings
authors.forename: Anho
authors.initials: A
authors.lastname: Liem
authors.forename: Jan Melle
authors.initials: JM
authors.lastname: van Dantzig
authors.forename: Wybren
authors.initials: W
authors.lastname: Jaarsma
authors.forename: Dirk J A
authors.initials: DJ
authors.lastname: Lok
authors.forename: Hans J A
authors.initials: HJ
authors.lastname: Kragten
authors.forename: Keesjan
authors.initials: K
authors.lastname: de Vries
authors.forename: Paul A R
authors.initials: PA
authors.lastname: de Milliano
authors.forename: Adrie J A M
authors.initials: AJ
authors.lastname: Withagen
authors.forename: Wilma J M
authors.initials: WJ
authors.lastname: Scholte Op Reimer
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.forename: Ron J G
authors.initials: RJ
authors.lastname: Peters
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000451:nursing*; D000368:Aged; D000553:Ambulatory Care; D016009:Chi-Square Distribution; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009426:Netherlands; D010353:Patient Education as Topic; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D055502:Secondary Prevention / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Coronary Artery Disease